That’s like stating that people who take Dilantin (antiepileptic) have seizures. Technically that’s correct, but it doesn’t address the reason people are using Dilantin in the first place, which is that they have epilepsy. This is the real source of their seizures, not the medication they take to control the seizures.

Yet this is exactly how recent studies evaluate opioid medication. They start by selecting a group of patients taking opioids and compare them to patients who don’t take them or take much less. Even if both groups have pain, they never consider varying levels of pain to be the legitimate reason for this disparity.

The particular study that made me question this type of design was the following:

This can be rewritten and make more sense as: “Patients with higher levels of pain tend to have worse pain, worse function, and higher healthcare utilization when compared with patients with lower levels of pain.”

Those who take opioids generally have more serious or consistent pain than those that don’t or take less, so the comparison is actually between people with serious pain and people with slight or no pain.

Below is an example showing how such studies mislead.

A. Theoretical study on the detrimental effects of Dilantin:

Study headline: People who take Dilantin have seizures

Study reality: Dilantin is correlated with seizures (seizures are correlated with Dilantin)

Media headline: Dilantin causes seizures

Reality: People who have epilepsy have seizures

B. Actual study on the detrimental effects of opioid medication:

Study headline: People who take opioids get depressed

Study reality: Opioids are correlated with depression (depression is correlated with opioids)

Media headline: Opioids cause depression

Reality: People who have pain get depressed

This problem is evident in most of the recent studies of opioids. The researchers claim to be studying the effects of opioids when they are really studying the effects of chronic pain. They blame any and all negative outcomes, like depression or a sedentary lifestyle, on the opioids instead of proceeding to the root cause, which is pain.

How can we compare opioid therapy to non-opioid-therapy without accounting for the fact that people are taking opioids because of their otherwise unmanageable pain? Opioid dosages are determined by pain levels and a pain patient’s drug tolerance over time, so pain level and opioid dosage usually change in tandem.

However, pain patients are always warned that opioids will not remove all our pain, so many of us still have to cope with considerable, and sometimes disabling, amounts of pain and its damaging effect on our bodies and minds.

Yet these studies seem to be trying to link the opioid-reduced remains of our full pain to the opioids we take to relieve our pain. Nowhere mentioned is the fact that opioids are prescribed to treat the pain symptoms that they claim are caused by those very same opioids.

Many studies seem structured to support the currently popular (and funded) anti-opioid campaign. Simply by measuring opioid dosages instead of pain levels, such studies can produce the desired conclusions.

No other health conditions are studied like this, using the amount of medication rather than the severity of the condition as an indicator. It seems an almost deliberate deception to shift the cause of troubling symptoms from the pain itself to the medication we take to ease the pain.

Another example: In the 1970’s, a study came out claiming that oat bran reduced cholesterol. What was not taken into account is that people eating oat bran so long ago were also unusually health-conscious and active. That’s what was lowering their cholesterol, not eating oat bran.

Eating “health food” was only one of many obscure factors correlated with general good health (like owning running shoes, paying attention to weather reports, not watching TV, or knowing your pulse rate).

In science, such misbegotten studies are common before the underlying causes of the issue being studied are known (like knowing that bacterial infection causes ulcers, not the foods we eat), but this can hardly be said about opioids.

So, why are the negative consequences of opioid therapy being studied, but not the consequences of pain or the ability of opioids to ease it?

Pain has so much variety in its location, amount, and character that it can only be vaguely estimated from self-reports. Opioid dosages, on the other hand, can be controlled and measured. So, much like the drunk looking for his keys under a streetlight instead of where he lost them because that’s where he can see, researchers are designing studies that use opioid doses as though they were independent of pain levels because that’s what can be measured.

Chronic pain negatively impacts our health in so many ways that these studies are finding all kinds of ill effects. But all the studies are designed to attribute these detrimental effects to the opioids we take to relieve our pain instead of the chronic pain itself.

In this way, even medical science has been corrupted by anti-opioid bias due to the persistent cultural meme that “opioids cause addiction”, which has even come to be regarded as common knowledge.

In this way, even medical science has been corrupted by anti-opioid bias due to the persistent, though untrue, cultural meme that “opioids cause addiction”. This myth has been repeated so often that it has come to be regarded as common knowledge.

And that makes it the most effective propaganda of all.

A question for you, dear readers:

I’ve been scientifically inclined since childhood and believe there’s always a reason for how scientific studies are designed, but in this case, I’m flummoxed. I hope someone with a better understanding of current research protocols can explain away this apparent design flaw I’ve detailed – and restore my faith in the NIH and its research.

You are exactly right. I have been following a lot of the regular media coverage of the “Opiod Debacle.” Just like the Depression Correlation, they flipped the script. This is deliberate, similar to the way they justify other things. Most of the coverage leaves out the fact, that the opiates were prescribed for a reason. Most of the discussion has been tailored to avoid the facts. These false narratives have been repeated for so long, they have become the “truth.”

You got it. I can thankfully share this now with many friends and family who need a darn good explanation of what’s hindering my daily functioning, and causing me to break from the normal performing human routine. It’s pain. They’re all glad I’m back to normal sometimes – but how do you tell them it’s because you got just enough relief from the opiates? Catch 22 of perception & reputation there :)

Zyp,
This is perhaps the best examination I’ve ever read that sheds light on the twisting of empirical data to fit an agenda…..and justify untruths…..massive propaganda campaign.
So sad, as so many are suffering now from all this rhetoric…oh wait, not so much..they are supposed to get better after medicine is withdrawn, right??
Not so much.
THANK YOU !!!

A pet theory of mine is that pain psych is a rather lucrative field and making all these catch 22s for us forces us into it. Meanwhile most if not all these newfound mental issues in patients who’s meds have been reduced are iatrogenic: they were caused by the doctors “treatment plan.” It makes another revolving door big money racket, facts and critical thinking be damned.

I agree with you and with Zyp’s excellent analysis. Since last year I’ve had to get my pain meds from a specialty “Spine & Pain Clinic” whose only business is pain management. They have a very nice clinic – which is me coyly inferring that there is a lot of money from patients, insurance, the government, and in research grants to be made in this newly fast growing field of medicine.

I would also point historically to Nixon’s “War on Drugs”. Having an agreed upon villain to blame makes it easier for those with power to get buy-in from the public for whatever they want to do by painting it as a necessary effort to defeat drug addiction, or in our case, the “opioid addiction epidemic”. And not just to restrict and better control the drugs, but vilify the weak willed addicts and punish the pushers and distributors. Whether the end game is accumulating and consolidating dollars and power or discriminating against a class of people without repercussions, the objective then, as it could be now, was to diminish obstacles and resistance and insure success.

I don’t THINK I’m a conspiracy nut, (“Then again, I do take opiates,” she said sarcastically.) but IMG’s “massive propaganda campaign” seems to me to fit what’s happening.

Originally the purpose of licensing doctors separately from pharmacists, was that the pharmacist would only sell the medicines the doctor prescribed.

A bartender makes money by selling whatever sort of whiskey or wine or beer he happens to have in stock.

It’s a problem to treat sick people by sending them to a bartender, because the likelihood is that the bartender has nothing that will actually help them recover,

Since the pharmacist has the same financial issue the bartender faces…he makes money by selling the medicines he has in storage…a law requiring pharmacies to fill prescriptions from a doctor, helps to limit this conflict of interest between the seller’s need for money and the buyer’s need for helpful medicine. The doctor’s prescription tells the pharmacist what medicine he’s allowed to sell this patient, for this specific ailment.

I think we’ve lost sight of that principle in our current national phobia about addiction. Yes, bartenders allowed Fred Trump to drink himself to death. That’s because bartenders and liquor store operators are licensed to collect liquor taxes for politicians. They’re no health professionals. They don’t take an overall interest in whether the customer is getting better or worse, And they completely lack any medical training at all.

If we’re to make sense of diseases that cause chronic pain, we have to start by recognizing the pathological nature of the disease itself. These are sick people and the pains they feel are a part of that sickness. Yes, they consume medicines to relieve the pains. And they consume other medicines for other aspects of their sickness. Yes, the medicines are “associated” with their sickness…it’s the entire reason a doctor put them on medication to begin with!

What’s causing all the confusion is that we’re not quantitating the impact of pain on the patient. Extreme disabling pain that interferes with breathing, defecating, urinating, drinking, eating, or walking, is an entirely-different subject, from a minor dull ache that’s completely forgettable. Pain that’s so severe as to cause a person to lay in bed and wait to die, is going to make every other aspect of that person’s health significantly worse. Absolutely that kind of severe pain is life-threatening and disabling. It requires treatment.

What sort of pencil-pushing medical theoretician could get into a policy-making position in government, and not comprehend a fact so basic?

Perhaps we need to send a few of those CDC officials in their Navy-style uniforms to Fort Leavenworth and have them move rock piles for 6 monthsf, to get them to really understand the difference between minor discomfort and major, disabling pain.

I absolutely agree. Studies look at opioid consumption as though there were no compelling reason to take them; chronic pain is never mentioned.

Studying a medication without any mention of the reason it’s being prescribed and taken is just nuts, and research would never be done like this with any other medications. Ignoring the pain for which opioids are prescribed nullifies their benefit and only explores their potential harms. Any other medications studied in this manner, ignoring the clinical indications for their use, would reach the same conclusion: all drugs are “bad for you” once you ignore their main purpose and benefit.

And I’m sure all of us pain patients fantasize about how the anti-opioid zealots themselves would react if they had to suffer the consequences of their own PROPaganda and resulting restrictions on effective pain relief.

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